CRP Test Validated and Rejected by Medicare

The Prescriber’s Letter of December 2008 led off with the story that high risk patients should be treated with a statin drug if their CRP sensitive test is elevated, even if their cholesterol is normal. They stressed that it was crucial to use the high-sensitivity test to detect this inflammation risk factor. In the same month Medicare informed practicing physicians that they would no longer pay for the high-sensitivity test. Medicare’s decision probably had more to do with cost than evidence-based medicine. But on second thought, maybe Medicare was correct, even if they did not use the correct reason. The study on CRP sensitive has hit the medical community like a bombshell to increase the use of statins. The study also showed that you have to treat 95 patients to prevent one major cardiovascular event, and side effects were not analyzed. By the way, the study was funded by the makers of Crestor, the most powerful statin on the market.

See Prescriber’s Letter, December 2008 issue.

FDA Warns about Newer Diabetic Drugs

The American Medical News reports that the FDA is really concerned about increased risk of heart attacks from the newer diabetic drugs, especially the TZD drugs Avandia and Actose. A December, 2008 Canadian Medical Association Journal article also found that the fracture risk for older women taking Avandia doubled. Even the old-time drugs like metformin and Glucotrol have not been shown to reduce the risk of heart attacks in type 2 diabetics. Your best bet to treat diabetes is diet and exercise. I am also impressed with using intravenous chelation therapy to reduce the MI risk in diabetics, although the proof is not there yet for chelation either.

See American Medical News 1/19/09 issue.

A New Risk Factor for Heart Disease

A very sensitive liver function enzyme test, the GGT, has been shown to be a biomarker for cardiac risk, oxidative stress and inflammation. Researchers in Germany found the GGT to be an independent risk factor for vascular disease, and it’s incredibly cheap at about $10 per test. If your GGT level is less than 13, your chances of a heart attack are practically nonexistent. The higher it goes, the worse your risk. The best way to lower liver enzymes is milk thistle (silymarin).

See the winter issue of Holistic Primary Care (subscription required) P. 6 and Meisinger C, et.al. Journal of Internal Medicine 2005; 258:527-535.

The Power of Hope

The Journal of the American Medical Association in their last issue of 2008 contained a wonderful editorial that some of my colleagues really need to listen to. They pointed out that physicians should remember “(every) encounter with a patient should leave the patient emotionally more able to deal with his or her illness….Most importantly, no patient should ever leave a visit with a physician without a sense of hope.” This is at the core if Integrative Medicine, and I endorse this “science of care” with enthusiasm.

See JAMA 2008, volume 300, No. 24, p. 2919 EXTRACT (membership required to see full text)

Call to Action to Prevent Pulmonary Embolism

Acting Surgeon General Steven K. Galson joined the Venous Coalition to issue a Call to Action to prevent deep vein clotting and pulmonary embolism. Coumadin is generally recommended for patients undergoing major surgery or prolonged bed rest at home or in the hospital, but is often not prescribed. Many patients who die of pulmonary embolism are misclassified as having suffered a heart attack. The true incidence of death from PE probably exceeds the total number of deaths from breast cancer, HIV disease and motor vehicle accidents combined. A natural way to help prevent the problem is to take fish oils, a least 1 tbsp a day, which we recommend for practically every adult patient.

National Heart, Lung, and Blood Institute and the Venous Coalition

Quit Smoking for Free

A study in the American Journal for Preventative Medicine (membership required) indicated that 85% of smokers preferred to contact a free telephone quit-smoking line to going to a doctor to stop smoking. Advantages include cost, convenience and anonymity. Experienced counselors will create an individualized quit plan for anyone who contacts them at the National Network of Tobacco Cessation Guidelines (1-800-784-8669). Offer this number to anyone you think might benefit. It is up to the smoker to make the phone call. Sometimes, all it takes is a nudge in the right direction.

National Network of Tobacco Cessation Guidelines (1-800-784-8669).

Food Allergies Increasing

A study by the National Center for Health Statistics showed that the incidence of food allergies in children increased by 19-24% in the decade beginning in 1997. This only included IGE-type food allergies manifesting in asthma, eczema, respiratory and digestive problems. The study did not include IGG-mediated reactions, which we have found to be the most common type of food allergies. Most children with any type of recurrent problem that affects the immune system should be tested for food allergies. Treatment can consist of avoidance of the offending food(s) or desensitization with such techniques as SRT and LDA, neither of which is commonly available but both of which are usually quite effective, in our experience. For more info contact COHA or go to healthcelebration.com.

Resources: National Center for Health Statistics and Family Practice News, November 1, 2008, P. 18

Avoid Plavix with Heartburn Drugs

The Associated Press reported this fall that patients who combine Plavix with acid-reducers such as Nexium, Protonix, and Prilosec greatly increase their risks of a heart attack, which is exactly opposite of the purpose of the Plavix. Most of the beneficial effect of Plavix is only in the first 30 days after a cardiac event. There are many natural and safer ways to make the platelets slippery and avoid clotting, including fish oils, garlic and nattokinase.

Family Practice News, November 1, 2008, p. 10
The Journal of American College of Cardiology, 2008
American College of Gastroenterology